Targeting zero catheter-related bloodstream infections in pediatric intensive care unit: a retrospective matched case-control study

Biasucci, Daniele Guerino; Pittiruti, Mauro; Taddei, Alessandra; Picconi, Enzo; Pizza, Alessandro; Celentano, Davide; Piastra, Marco; Scoppettuolo, Giancarlo; Conti, Giorgio

doi:10.5301/jva.5000797

Cited by 33 publications

(20 citation statements)

References 29 publications

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“…They also clearly state that more than 70% of the "TL" are totally implanted ports: while the definition of ports as "TL" is somehow inappropriate, ports notoriously have a low rate of infective complications. 2,6,[14][15][16][17][18][19] However, in our opinion, a comparison between ports and PICCs has little clinical sense, since these devices have different indications (intermittent long-term use for ports vs continuous short-to medium-term use for PICCs), as clearly stated in the INS standards of practice. 5 Moreover, 30% of "TL" in the study were tunneled CICCs.…”

Section: Another Issue Is Related To Technique Of Insertionmentioning

confidence: 97%

In defense of the use of peripherally inserted central catheters in pediatric patients

et al. 2020

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Central venous access devices have revolutioned the care of children affected by malignancies, facilitating management of complex and prolonged infusive therapies, reducing pain and discomfort related to repeated blood samples and indiscriminate venipunctures, thus reducing also psychological stress of both patients and families. In this respect, peripherally inserted central catheters have been disseminated for use, even in pediatric oncology patients, for their many advantages: easy and non-invasive placement with no risk of insertion-related complications, as well as easy removal; reduced need for general anesthesia both for insertion and removal; adequate prolonged performance also for challenging therapies (e.g. stem cell transplantation); and low rate of late complications. Nonetheless, concerns have been recently raised about use of such devices in children with cancer, especially regarding a presumed (but not demonstrated) high risk of catheter-related venous thrombosis. Are we facing a new witch (or peripherally inserted central catheter) hunt? The choice of the central venous access device—particularly in oncologic children—should be based on an evaluation of clinical advantages and risks, as provided by appropriate and scientifically accurate clinical studies.

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Section: Another Issue Is Related To Technique Of Insertionmentioning

confidence: 97%

In defense of the use of peripherally inserted central catheters in pediatric patients

et al. 2020

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“…An increased effect was observed in the case of an initial ID greater than or equal to 5/1000 catheter-days [ 132 ]. A programme including recommendations on catheter placement, maintenance and education may contribute to achieving a “Zero infection” target [ 252 ]. Future studies should address the various cannulation methods of the IHI bundles and the impact of compliance with the prevention programme on the course of CRI and healthcare-related infections.…”

Section: Summary Of the Resultsmentioning

confidence: 99%

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

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Bernard

et al. 2020

Ann. Intensive Care

113

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The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.

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“…One previous study by Habas et al specifically assessed the risk of CLABSI with US-guided supraclavicular BCV cannulation against other CVC insertion sites (femoral, internal jugular vein, and infraclavicular subclavian vein) in older children in the pediatric intensive care unit (PICU), with the authors reporting a reduced CLABSI density rate (BCV, 2.8/1000 days vs other-CVC, 8.96/1000 days; p = 0.006) [28]. In a retrospective analysis, Biasucci D et al observed a remarkable reduction in CLABSI from 15/1000 to 1.5/ 1000 days after the implementation of a CVC insertion bundle in the PICU [29]. The bundle included systematic assessment of central veins using the RaCeVa protocol and resulted in a radical shift in the choice of CVC insertion site in favor of the BCV (from 0 to 85% after bundle implementation) [30].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein may reduce central line–associated bloodstream infection in preterm infants

et al. 2020

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The objective of this study was to assess the risk of central line-associated bloodstream infection (CLABSI) of ultrasound (US)guided cannulation of the brachiocephalic vein (BCV) compared to standard epicutaneous cava catheters (ECCs) in preterm infants. This was a retrospective cohort study in preterm infants with a birth weight of less than 1500 g. Each BCV catheter was matched 1:3 with ECCs according to sex, birth weight, and year of insertion. The main outcome was the CLABSI density rate per 1000 days. Secondary outcomes included CLABSI episodes, CLABSI episodes per infant, and CLABSI/death. A multivariate Cox regression analysis was performed to assess whether the type of catheter (ECC vs. BCV) was associated with CLABSI risk. Ninety-six catheters (21 BCVs and 75 ECCs) in 79 infants were included (993 catheter days). BCV catheters were associated with a reduced CLABSI density rate compared to ECCs (3.05/1000 days vs 21.1/1000 days; p < 0.001). ECCs were associated with increased CLABSI risk compared to BCV catheters in multivariate analysis (hazard ratio 36; (95% CI, 2.5-511); p = 0.008).Conclusion: US-guided supraclavicular cannulation of the BCV was associated with a reduced risk of CLABSI compared to ECCs. This finding deserves further multicenter research. What is Known:• An epicutaneous-cava catheter (ECC) is commonly used in preterm infants for routine care (eg. delivery of nutrition and antibiotics) but this device may not suffice in infants who need high-intensity care (multiple drugs, hemodynamic monitoring, fluid resuscitation etc.). • Ultrasound-guided brachiocephalic vein (BCV) catheterization has shown a high success rate and few immediate complications in neonates and small infants but it has never been compared to standard ECCs. What is New: • When the operator in properly trained, US guided cannulation of the BCV in preterm infants is feasible, safe and may reduce the risk of CLABSI compared to standard ECCs. • This fact may expand the use of BCV catheters in selected high-risk preterm infants who need a large bore venous access.

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Targeting zero catheter-related bloodstream infections in pediatric intensive care unit: a retrospective matched case-control study

Cited by 33 publications

References 29 publications

In defense of the use of peripherally inserted central catheters in pediatric patients

In defense of the use of peripherally inserted central catheters in pediatric patients

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein may reduce central line–associated bloodstream infection in preterm infants

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